Cemented Versus Uncemented Reverse Shoulder Arthroplasty Treatment of Proximal Humerus Fractures: National Shoulder Arthroplasty Data from Türkiye.

Background: This study evaluated national trends in cemented and uncemented reverse shoulder arthroplasty (RSA) for proximal humerus fractures using a comprehensive national surgical database. This study aimed to compare RSA used in the treatment of proximal humerus fractures with the literature and to determine the country's trend. Methods: A cross-sectional study was conducted using the health records of individuals aged ≥ 18 years who underwent RSA for proximal humerus fractures between 2016 and 2022. Patients were divided into cemented and uncemented groups, and demographic data (age, sex), duration of hospital stay, transfusions, revisions, mortality, and Charlson Comorbidity Index (CCI) scores were analyzed. Results: A total of 618 cemented RSA and 1,364 uncemented RSA procedures were reviewed. Patients who underwent cemented RSA were significantly older than those who had uncemented RSA (p = 0.002). Transfusion rates were higher in the cemented RSA group (p = 0.006). The frequency of revision surgery was 6.1%. Younger age and male sex were associated with revision (p < 0.001). CCI scores were higher among transfused patients than non-transfused patients (p < 0.001). The incidence of cemented RSA was 11.7% and 49% in 2016 and 2022, respectively. Differences were found among hospital types and geographical regions. Conclusions: While cemented RSA has been gaining attention and increased application in recent years for proximal humerus fractures, uncemented RSA still predominates. The choice between these 2 methods is largely influenced by regional and hospital-level factors. The type of RSA and high CCI scores were found to have no significant impact on the risk of surgical revision.

A comparison of isokinetic muscle strength in patients with chondromalacia patella: a cross-sectional study.

OBJECTIVE: Chondromalacia patella (CMP), which is one of the most common causes of anterior knee pain in young adults, is often accompanied by reflex inhibition of the quadriceps muscle. In this respect, a significant correlation between isokinetic parameters and knee muscle strengths would be expected. We hypothesized that an isokinetic dynamometer, which objectively evaluates muscle strength, may be an important guide in detecting muscle weakness in new-onset CMP and determining early treatment strategies. PATIENTS AND METHODS: A total of 113 participants (mean age 30.33 ± 6.96 years, min: 18, max: 44) were recruited and divided into two groups, thus a CMP group (n=48) and a control group (n=65). The symptom duration of the CMP group and the demographic characteristics of all participants were recorded. Knee flexion and extension muscle strengths were measured at angular velocities of 60°/s and 180°/s [Knee extension Peak Torque at 60°/s (PTE60), Knee flexion Peak Torque at 60°/s (PTF60), Knee extension Peak Torque at 180°/s (PTE180), Knee flexion Peak at 180°/s (PTF180) respectively] (five sets) using an isokinetic dynamometer. We also recorded the total work done in flexion and extension (TWDF and TWDE). A modified MRI staging system based on the Outerbridge arthroscopy system was used to stage CMP. Isokinetic dynamometric parameters were compared between CMP patients and healthy volunteers. RESULTS: 59 healthy volunteers (90.8%) were right-side dominant and 6 (9.2%) left-side dominant. 33 CMP patients (68.8%) were right-side dominant, and 15 (31.3%) left-side dominant. 20 (41.7%) CMP patients were classified as Stage 1, 20 (41.7%) as Stage 2, and 8 (16.7%) as Stage 3. All the PTF60, PTE60, PTF180, and PTE180 values were significantly lower in the CMP group than in healthy controls (all p < 0.05). CMP symptom duration ≥ 6 months was associated with significantly lower knee muscle strength than with symptom duration < 6 months (p < 0.05). Also, a statistically negative correlation was found between MRI stages and PTE60 values (p < 0.05). CONCLUSIONS: In conclusion, our findings show that the isokinetic dynamometer reveals muscle weakness in CMP patients, and weakness in isokinetic parameters was negatively correlated with symptom duration and MRI stages. Isokinetic knee muscle strength testing, together with other functional tools, enables the assessment of muscle weakness and early rehabilitation planning for patients with CMP.

Stabilization of chevron osteotomy with a capsuloperiosteal flap: Results in 15 years of follow-up.

PURPOSE: Distal chevron osteotomy (DCO) is used more frequently than other methods for the correction of mild-to-moderate hallux valgus deformity because it is markedly more stable. Here, we evaluated the use of a capsuloperiosteal flap to stabilize DCO and presented our last longer follow-up. METHODS: This study included a total of 57 patients (86 feet) made up of 50 women (79 feet) and 7 men (7 feet) with a mean age of 37.8 years who were diagnosed with hallux valgus and met the inclusion criteria. These patients received treatment using a capsuloperiosteal flap to stabilize DCO from 1994 to 2000. Clinical outcomes of the patients were assessed using the American Orthopaedic Foot and Ankle Society hallux scale. RESULTS: The mean follow-up duration was 14.8 years. The score increased from a preoperative mean of 52 points to a mean of 90.5 points at last follow-up. The mean hallux valgus angle changed from 30.3° preoperatively to 14.4° postoperatively at the last follow-up. The first to second intermetatarsal angle changed from 13.6° preoperatively to 10.5° postoperatively. The correction in the range of motion proved to be consistent with only an average of 1° correction loss and 5.5° loss. Eighty-four feet (97.6%) were pain-free. Discomfort with shoe wear was absent in 82 feet (95.3%) postoperatively, and 23 of 24 (95.8%) patients were fascinated cosmetically. CONCLUSION: Correction of mild-to-moderate hallux valgus deformity with the use of capsuloperiosteal flap for stabilization of DCO provided findings comparable with the literature regarding clinical and radiological outcomes at long-term follow-up. Level of Evidence: IV, Retrospective Case Series.

Treatment alternative for irreparable rotator cuff ruptures: Arthroscopic biodegradable balloon.

BACKGROUND: The treatment of massive irreparable rotator cuff rupture has still no consensus among shoulder surgeons. It is assumed that symptomatic rotator cuff tendon rupture is accepted as irreparable if retraction amount of tendon is Patte stage 3 on MRI; degree of fatty atrophy is Goutallier stage 3 or 4; narrowing of acromiohumeral distance is lesser than 7 mm and excursion of tendon to repair has decreased and patient has severe pain. Biodegradable balloon is one of the newest methods for the treatment of irreparable massive rotator cuff ruptures. OBJECTIVE: The aim of this study was to assess shoulder function in the patients who underwent biodegradable balloon procedure for irreparable massive rotator cuff ruptures. MATERIALS AND METHODS: Arthroscopic biodegradable balloon method was carried out on the 12 patients, who presented with symptomatic irreparable massive rotator cuff rupture, from October 2010 to November 2013. RESULTS: Preoperative and postoperative mean constant score of patients were 25.8 and 75.4 respectively. The mean Oxford shoulder score of the patients were 21.3 and 42.9 respectively, and mean shoulder abduction degree of the patients were73.5 and 165 respectively. All the patients stated that they were satisfied with the treatment and there was significant regression in their complaints. CONCLUSION: If conservative treatment is insufficient for patients with irreparable rotator cuff tears, biodegradable balloon method has yielded favorable outcomes in terms of pain and functionality in comparison with other surgical methods. Moreover, lesser morbidity, short procedure time and absence of postoperative rehabilitation requirement can be considered as advantages of this method.

Post operative pain management in shoulder surgery: Suprascapular and axillary nerve block by arthroscope assisted catheter placement.

BACKGROUND: Postoperative pain management is the part of shoulder surgery to improve patient satisfaction, start rehabilitation process rapidly and decrease for hospital stay. Various treatment modalities have been used for pain management, but they have some limitations, side effects and risks. Throughout intraoperative and postoperative period, nerve blocks have been used more popularly than others because of efficacy. For the regional nerve block, local anesthetic should be infiltrated close to the nerve for maximum effect. Consequently, aim of this study was to evaluate analgesic efficacy when catheters are placed with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia. MATERIALS AND METHODS: 24 patients (5 males, 19 females; mean age: 54.3 years) who underwent arthroscopic repair of rotator cuff between June 2014 and September 2014 and were catheterized to block suprascapular and axillary nerves during shoulder arthroscopy were included in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2. RESULTS: Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.38 ± 0.77, 0.44 ± 0.42, 0.58 ± 0.42, 0.63 ± 0.40, 0.60 ± 0.44, 0.52 ± 0.42, and 1.55 ± 0.46, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, comparison of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference (P < 0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38 ± 3.21 and 3.75 ± 0.85, respectively. CONCLUSION: These results demonstrated that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients' satisfaction could be improved.

Long-term Results of Chronic Achilles Tendon Ruptures Repaired With V-Y Tendon Plasty and Fascia Turndown.

BACKGROUND: This study aimed to evaluate the long-term follow-up results of V-Y tendon plasty with fascia turndown, for repairing chronic Achilles tendon ruptures. METHODS: Seventeen patients (12 males, 5 females), who were diagnosed with chronic Achilles tendon rupture and met the inclusion criteria, were included in the study. These patients received treatment by means of V-Y tendon plasty with fascia turndown from January 1995 to December 2001. Clinical outcomes of the patients were assessed by using isokinetic strength testing, questioning the patient regarding residual discomfort, pain, or swelling and having the ability to perform heel rises and using American Orthopaedic Foot & Ankle Society's (AOFAS's) Ankle-Hind Foot Scale score. Mean follow-up duration was 16 years (13-18 years). RESULTS: Mean time from the injury to operative treatment was 7 months. Mean operative defect of Achilles tendon in neutral position after debridement was 6 cm. During the follow-up, the mean calf atrophy was 3.4 cm. The mean 30 degrees/s plantarflex and 120 degrees/s plantarflex peak torques were 89 and 45 Nm, respectively. The mean 30 degrees/s plantarflex peak torque deficiency was 16%. The mean 120 degrees/s plantarflex peak torque deficiency was 17%. The average peak torque deficiency was 17%. The pre- and postoperative mean AOFAS Ankle-Hindfoot Scale scores were 64 and 95, respectively. No patient had a rerupture. Superficial wound infection was treated with oral antibiotic therapy in 2 patients (11%). CONCLUSIONS: The V-Y tendon plasty with fascia turndown for repairing chronic Achilles tendon ruptures yielded results comparable with the literature regarding clinical outcomes. This method did not require synthetic materials for augmentation and was an economic alternative compared to other repair methods. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Arthroscopic stabilization of anterior shoulder instability using a single anterior portal.

OBJECTIVE: The aim of this study was to compare the effects of the use of a single anterior portal in the arthroscopic surgery treatment of traumatic anterior shoulder instability with those in the literature. METHODS: The study included 72 patients (60 males, 12 females; mean age: 23.9 years) who underwent surgery using a single arthroscopic anterior portal for the treatment of traumatic anterior shoulder instability between 2002 and 2011. Clinical outcomes were assessed using the Rowe and Oxford scales, forward flexion range and external rotation limitation. Redislocation was considered failure. RESULTS: Mean follow-up was 49.3 months. Bankart lesion was determined in 38 patients and Bankart and SLAP lesions in 34. An average of 3.7 (range: 2 to 5) anchors were used. Redislocation was observed in 4 (5.6%) patients in the postoperative period. Postoperative Rowe and Oxford scores were 93.4 and 42.6, respectively. CONCLUSION: Instability surgery performed using a single arthroscopic anterior portal provided findings comparable with the literature regarding clinical outcomes, postoperative shoulder movements and low recurrence rates, emphasizing the importance of appropriate patient selection rather than the number of the portals. The use of a single portal is less invasive and reduces the surgical period.

Posterior tibial nerve as a tendon transfer for drop foot reconstruction: a devastating complication.

Iatrogenic peripheral nerve injuries can result from numerous medical procedures, particularly transection, stretching, compression, injections, heat, radiation, and the use of anticoagulant agents. Late diagnosis may lead to atrophy of the motor endplate and result in poor outcomes. We report a case in which the posterior tibial nerve was accidentally sectioned as the posterior tibial tendon for transfer to the anterior tibial tendon in the reconstruction of drop foot. This iatrogenic complication ultimately required foot amputation. Physicians must be aware of the anatomy of the posterior tibial nerve in order to avoid such complications.

Pulmonary thromboembolism after surgical treatment of ulnar pseudoarthrosis: a case report.

Deep vein thrombosis (DVT) and the consequently developed pulmonary embolism are devastating complications in orthopedic surgery. DVT occurs less frequently (1-2% of all cases) in the upper extremity than the lower extremity. We report a 54-year-old male patient who developed DVT and pulmonary thromboembolism after surgical treatment of an ulnar pseudoarthrosis. The presented case suggested the use of a low molecular weight heparin prophylaxis after upper extremity surgeries necessitating long-term immobilization.